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Explore the susceptibility of SHPT patients to adverse outcomes

17 September 2021

Study investigates the impact of SHPT on the risks of fractures, cardiovascular events and other adverse outcomes1

In a 2021 study published in the Clinical Kidney Journal, Dr Yang Xu* and colleagues help to shed light on the incidence of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) and the susceptibility of SHPT patients to adverse health-related outcomes.1

Study goals

Looking at data from the Stockholm Creatinine Measurements (SCREAM) project, the goals of the study were to:1

  1. Quantify the incidence rates of SHPT in stages 1 to 5 CKD
  2. Evaluate the risks of death, major adverse cardiovascular events (MACEs), CKD progression and bone fractures in SHPT patients

Study design

An evaluation was made of all adults who:1

  • Were receiving nephrologist care in Stockholm from 2006 to 2011
  • Were not undergoing kidney replacement therapy
  • Had no sign of SHPT at index date/baseline

After identifying incidences of subsequent SHPT development, the incidences were characterised by estimated glomerular filtration rate (eGFR), and the association between SHPT and the adverse outcomes of interest were quantified.1

Incidences of SHPT were identified based on either a diagnosis being made, a treatment (calcimimetics or active vitamin D) being initiated, parathyroidectomy being performed and/or two consecutive parathyroid hormone (PTH) tests ≥130 pg/mL being encountered.1

Study results

The incidence of SHPT increased with CKD stage1

A total of 2,556 CKD patients were included in the analysis.1

During a median follow-up of 2.4 years, 784 (31%) of the patients developed SHPT, with an overall incidence of 114.9 per 1,000 person-years.1

The incidence of SHPT increased with CKD progression, highlighting a strong inverse relationship between eGFR and SHPT risk (Table 1).1,2

Table 1. SHPT incidence rates by CKD stage2
graph

Adapted from Xu Y et al. 2021.2

SHPT increased the risks of all four investigated adverse outcomes1

After multivariable adjustment, the development of SHPT was associated with an increased risk of death, fractures, MACEs and CKD progression (Figure 1).1

Figure 1. Increased risk of adverse health-related outcomes in patients with SHPT vs without SHPT1
graph

HR: hazard ratio; RR: rate ratio.

Adapted from Xu Y et al. 2021.1

These findings expand on previous studies that produced similar results regarding the negative impact of SHPT on mortality,3,4 fractures,3 cardiovascular events3 and CKD progression.4

Key takeaways

  • The incidence of SHPT increases with CKD progression, with 57 incidences per 1,000 person-years by stage 3 CKD1
  • Compared with patients without SHPT, patients with SHPT are at higher risk of death, fractures, MACEs and CKD progression1

These findings not only illustrate the burden of SHPT in CKD but can also be used to inform clinical decisions regarding pre-SHPT risk stratification, PTH monitoring and risk-prevention strategies post-SHPT development.1

To read the full paper by Dr Xu and colleagues and evaluate the clinical implications of the results, please refer to the Clinical Kidney Journal website.

 

Footnotes and references

*Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.

 

1. Xu Y et al. Clin Kidney J. 2021;sfab006.

2. Xu Y et al. Clin Kidney J. 2021;sfab006. Supplementary information.

3. Geng S et al. Osteoporos Int. 2019;30:2019–25.

4. Schumock GT et al. Curr Med Res Opin. 2008;24:3037–48.